Capitellum and Capitellar-Trochlear Shear Injury in Children.

Abstract

We report our clinical results following surgical intervention for capitellar fractures in a pediatric population, highlighting approaches, surgical instruments, and possible prognostic factors. Retrospective descriptive case-series study. A tertiary referral hospital. Twelve pediatric patients with capitellar or capitellar-trochlear injuries were treated between 2017 and 2021. Open reduction and internal fixation primarily using cannulated headless screws. The mean follow-up period was 22 months (range: 10-35 months). Functional outcomes were assessed using the Mayo Elbow Performance Score. Post-traumatic elbow arthrosis was assessed using the Bromberg and Morrey rating system. All fractures healed within 5-7 weeks. The mean Mayo Elbow Performance Score value was 98 (range, 85-100). Three patients developed arthrosis, and one had capitellar osteonecrosis. Based on our experience, the Kocher approach and fixation of 2-3 retrograde cannulated screws together represent an appropriate surgical technique for isolated capitellar fractures, whereas good functional outcomes are attainable for capitellar-trochlear shear fractures using the transolecranon approach with 3 cannulated screw fixations. Further injuries to the osseoligamentous structures around the elbow joint are suspected to be an unfavorable prognostic factor. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.